New India Senior Citizens Mediclaim Policy

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New India Senior Citizens Mediclaim Policy

	Objective			Objective of the policy is to cover senior citizens- a stage of life cycle when insurance is most required.
Suited for			Anyone between 60 and 80 years of age looking for a coverage up to Rs 1.5 lakh can take this policy.
What does it do?			This policy pays for senior citizens' hospitalisation expenses, pre and post hospitalisation expenses, though with sub-limits. It covers ayurvedic, homeopathic and Unani treatment as well. An added advantage is that it covers pre-existing hypertension, diabetes mellitus for an additional 10 per cent premium payment. In the event of four claim-free years, the insured person can get reimbursement for a health check-up.
Pros			Cover can be extended upto 90 years of age. Family discount of 10 per cent is available if spouse is also covered. Premium discount of 10 per cent is available for taking a voluntary deductible. A bonus of 5 per cent is paid for each claim free-year upto a maximum of 30 per cent of initial sum insured. Provision to cover pre- existing hypertension, diabetes mellitus on payment of additional 10 per cent premium. Premium paid is eligible for tax benefit under section 80D of the Income Tax Act.
Cons			It allows to take a maximum sum assured upto Rs 1.5 lakh only and has a shorter freelook period of 10 days. The premium will be loaded by 10 per cent for renewals during 81 to 85 years and by 20 per cent during 86 and 90 years. It has sub-limits.
Our View			A decent policy for senior citizens, where voluntary deductible option can be availed. The major drawback is that it offers a maximum of 1.5 lakh cover only which may not be sufficient at this age. It is difficult to escape sub-limits at this age.
Eligibility
Entry Age (years)
Minimum		60
Maximum		80
Maximum Policy Renewal Age (years)		90
Coverage Type		Senior Citizens
Policy Term (years)		1
Sum Insured (Rs)
Maximum		1.5 lakh
Minimum		1 lakh
Tax Benefit		Section 80D of the Income Tax Act are applicable
Discount		Family discount of 10% if spouce is also covered discount of 10% for taking a voluntary deductible of Rs 10000
No Claim Bonus		5% for each claim free year upto maximum of 30% of initial Sum insured. On acceptance of claim during any policy year, entire cumulative bonus earned shall be withdrawn in subsequent policy year.
Pre Policy Medical Check Up		Mandatory
Free look Period		10 days
Premium Loading on Basis of Claim History		Loading of 10% is applicable for renewal between age of 81- 85 years and 20% on renewal between age of 86-90 years
Policy Termination		Insurer may cancel the policy by giving a 30 days written notice to policyholder. Policyholder may also cancel the policy at any time by giving a written notice to insurer. In case policyholder cancelling the policy, a certain percentage of premium would be refunded on prorata basis.
Customer Service		The New India Assurance Co. Ltd Jeevan Bharti Building, Corporate Office: 87, M.G Road, Fort, Mumbai 400001; Regional Office: 124 Connaught Circus, New Delhi-110001
Customer Service
Mail to		nia.310000@newindia.co.in
Call to		1800 209 1415
Network Hospitals		Http://newindia.co.in/listofhospitals.aspx

 

	Scope Of Cover
Cashless Facility		Available at network hospitals
Reimbursement Facility		Available if treatment taken at any non empanelled hospital
Pre-hospitalisation		covers medical expenses upto 30 days immediately prior to hospitalisation subject to maximum of 5% of hospital bill
Post-hospitalisation		covers medical expenses upto 60 days immediately post discharge from hospital subject to maximum of 10% of hospital bill
Inpatient Hospitalisation		Covered
Room rent/ ICU expenses		Room rent and boarding expenses will be covered upto 1% of Sum Insured per day and ICU expenses will be covered upto 2% of Sum Insured per day subject to an overall limit of 25% of Sum Insured
Surgeon, Anaesthetist, Medical Practitioner, Consultant's Specialist fees		covered upto maximum of 25% of Sum Insured
Anaesthesia, blood,oxygen, OT charges, surgical appliances, medicines, drugs, diagnostic material, X Ray and artificial implants		Covered upto maximum of 50% of Sum Insured
Ayurvedic/ Homeopathic/ Unani treatment		Covered upto maximum 25% of Sum Insured
Emergency ambulance		Covered upto maximum of Rs 1000
Expenses for organ donor of transplant		Covered
Pre existing hypertension, diabetes mellitus		will be included in cover since inception of policy only on payment of additional premium of 10% of basic premium for each condition
Domiciliary Treatment		Not Covered
Health Check Up		allowed once after every 4 claim free years maximum upto 1% of sum insured excluding cumulative bonus

 

	Exclusions and Waiting Period
Pre-existing Diseases		Covered after a period of 18 months
No claim period		30 days commencing from inception of policy except for accidental injuries
Waiting Period		Certain diseases such as hernia, diabetes, mellitus, cataract etc. will be covered after a waiting period of 18 months.Age related Osteoarthritis and Osteoporosis and joint replacement due to degenerative condition will be covered after a waiting period of 48 months.
Deductible		Voluntary deductible of Rs 10000 is applicable
General Exclusions		Self inflicted bodily injury Dialysis, Chemotherapy and radiotherapyDental treatment, Cost of spectacles, braces and contact lensesNaturopathy treatmentEngagement in any illegal or criminal activitiesBodily injury arising as a result of terrorismbodily injury or disease caused as a result of HIV/ AIDS or any related conditionEngagement in adventurous acts such as parachuting, bunjee jumping etc

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